Variance in Clostridium difficile surveillance reporting: implications for quality improvement outcomes

Kathryn Daveson 1,2, Caroline Wilson 1, Andrea Menzies 1

ACT Health, Garran, ACT, Australia

Australian National University, Canberra, ACT, Australia


Introduction: Clostridium difficile infection (CDI) is an important cause of health-care associated (HCA) diarrhoea and important indicator of infection prevention and control (IPC) and antimicrobial stewardship (AMS) programs. It is foreseeable that this may become a mandatory reporting process in the future. However, the utility of using HCA-CDI or hospital-identified (HI) CDI surveillance indicators for quality improvement purposes may differ depending on institutional CDI epidemiology. The aim of this study is to identify the impact of CDI reduction in HI-CDI or HCA-CDI terms using a theoretical quality improvement program using real-life surveillance data.

Methods: Cases identified between 2012-2014 from a prospectively, collected CDI surveillance database, stratified by Australian CDI definitions were used as the cohort for analysis. A sensitivity analysis was performed on HCD-CDI and HI-CDI rate reduction for a hypothetical quality improvement program that reduced HCA-CDI rates by 50%.

Results: The rate of HCA-CDI and HI-CDI was 4.9 and 7.4/10 000OBD respectively. The HCA-CDI to HI-CDI ratio was two thirds. The proportion of HCA-CDI to HI-CDI cases decreased, the difference in rate reduction between HCA-CDI and HI-CDI rates increased. The threshold at which institutions should consider reporting HCA-CDI as opposed to HI-CDI for quality improvement purposes is a ratio of HCA-CDI:HI-CDI of between 60 and 70%.

Conclusion: The utility of HI-CDI as a marker of HCA-CDI quality improvement changes based on institutional CDI epidemiology. IPC and AMS programs should take this into account when deciding what surveillance indicator should be used to demonstrate quality improvement in their institution

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